Fibrin glue for refractory hemorrhagic cystitis after unrelated marrow, cord blood, and haploidentical hematopoietic stem cell transplantation.
BACKGROUND
Patients undergoing hematopoietic stem cell transplant (HSCT) are particularly exposed to the risk of developing hemorrhagic cystitis (HC), which is characterized by symptoms ranging from macroscopic hematuria to renal failure. Although HC significantly affects the quality of life and in a few cases becomes intractable leading to patient death, its therapeutic management has not been established. Fibrin glue (FG), a hemostatic agent derived from human plasma, has been largely employed in different surgical settings including urologic procedures.


METHODS
In this pilot study we used FG to treat refractory HC. During cystoscopy, bladder distension was maintained at a constant pressure of 12 mmHg by a carbon dioxide insufflator. An endoscopic applicator allowed spraying FG on the bleeding and raw surfaces of bladder mucosa.


RESULTS
Five of 221 patients undergoing an HSCT developed a very severe, refractory HC and have been treated with endoscopic FG. The treatment was successful in 3 patients; the response was partial in 1 patient and transient in the last one, whose clinical course was severely complicated by acute graft-versus-host disease and multiple organ failure.


CONCLUSIONS
FG therapy is a feasible procedure and this pilot study suggests that it may be an effective treatment for refractory HC. Its application could be considered also in Grade 1 or 2 HC to prevent progression of damaged mucosa. The use of FG for HC should be prospectively investigated in terms of therapeutic efficacy, transfusion support, length of hospitalization, quality of life, and costs.
Tirindelli
Maria Cristina
MC
Department of Hematology, Campus Bio-Medico University Hospital, Rome, Italy. m.tirindelli@unicampus.it
Flammia
Gerardo
G
Sergi
Federico
F
Cerretti
Raffaella
R
Cudillo
Laura
L
Picardi
Alessandra
A
Postorino
Massimiliano
M
Annibali
Ombretta
O
Greco
Rosa
R
Avvisati
Giuseppe
G
Arcese
William
W
D000293:Adolescent; D000328:Adult; D003556:Cystitis / Q000209:etiology / Q000628:therapy*; D003558:Cystoscopy / Q000379:methods; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology*; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D014184:Transplantation, Homologous
D015718:Fibrin Tissue Adhesive